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Case Reports
. 2019 Jul;19(4):321-324.
doi: 10.7861/clinmedicine.19-4-321.

Pneumomediastinum as a complication of cocaine abuse

Catriona Macrae  1 , Christopher Brown  2 , Christine Aiken  2 , Ravi Jamdar  2
Affiliations
Case Reports

Pneumomediastinum as a complication of cocaine abuse

Catriona Macrae et al. Clin Med (Lond). 2019 Jul.

Abstract

A 26-year-old male presented with a 24-hour history of pleuritic chest pain following intranasal cocaine insufflation. He was a smoker, cannabis and alcohol user. Cardiovascular and respiratory examinations were unremarkable.His admission blood tests were within normal limits. The admission electrocardiogram (ECG) showed sinus rhythm, with ST-segment elevation in an inferolateral distribution. This appeared to be an early repolarisation abnormality, with no evolving changes.His chest radiogram showed a double outline at the left heart border with subcutaneous gas collection over the left supraclavicular fossa but no evidence of pneumothorax. A computed tomography (CT) showed prominent mediastinum with gas tracking into the neck but no connection to the oesophagus or pneumothorax.He was managed conservatively and a repeat chest radiogram after 48 hours showed improvement.

Keywords: Chest pain; cocaine; pneumomediastinum.

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Figures

Fig 1.
Fig 1.
Admission electrocardiogram.
Fig 2.
Fig 2.
Chest radiogram demonstrating pneumomediastinum.
Fig 3.
Fig 3.
Computed tomography showing air in the mediastinum.
Fig 4.
Fig 4.
Computed tomography showing free air, tracking into the anterior neck.
See this image and copyright information in PMC

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